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Focuses on obstructive sleep apnea. Discusses causes, including narrowed airways and obesity. Covers symptoms like snoring, gasping during sleep, and daytime sleepiness. Info on treatment with CPAP and oral or nasal breathing devices.

Sleep Apnea

Topic Overview

What is sleep apnea?

Sleep apnea means that
your breathing often is blocked or partly
blocked during sleep. The problem can be mild to severe, based on
how often your lungs don't get enough air. This may happen from 5 to
more than 50 times an hour.

This topic focuses on obstructive sleep apnea, which is the most common
type.

A less common type of apnea, called central sleep apnea,
can occur in people who have had a stroke, have heart failure, or have a brain
tumor or infection. Even though this topic isn't about central sleep apnea,
some of the treatments discussed here may also help treat it. Talk with your
doctor to find out more about central sleep apnea.

What causes obstructive sleep apnea?

Blocked or
narrowed airways in your nose, mouth, or throat can cause sleep apnea. Your
airways can become blocked when your throat muscles and tongue relax during
sleep.

Sleep apnea can also occur if you have large
tonsils or adenoids. During the day, when you are awake and standing up, these may not cause problems. But when you lie down at night, they can press down on your airway, narrowing it and causing sleep apnea. Sleep apnea
can also occur if you have a problem with your jawbone.

In
children, the main cause of sleep apnea is large
tonsils or adenoids.

Sleep apnea is more likely to occur if you are
overweight, use certain medicines or alcohol before bed, or sleep on your
back.

What are the symptoms?

The main symptoms of sleep apnea that you may
notice are:

Not feeling rested after a night's
sleep.

Feeling sleepy during the day.

Waking up with a
headache.

Your bed partner may notice that while you sleep:

You stop breathing.

You often snore
loudly.

You gasp or choke.

You toss and turn.

Children who have sleep apnea:

Nearly always snore.

May
be hyperactive or have problems paying attention during the
day.

May be
restless during sleep and wake up often. They also may have problems
with bed-wetting.

But children may not seem very sleepy during the day (a key
symptom in adults). The only symptom of sleep apnea in some children may be
that they do not grow as quickly as most children their age.

If you have
sleep apnea, you also may not be sleeping as well as you could. If you feel sleepy during the day and this gets in the way of the normal things you do (like work, school, or driving), it's important to talk to your doctor. Be safe. Do not drive while you are drowsy.

How is sleep apnea diagnosed?

Your doctor will probably examine you and ask about your past health. He
or she may also ask you or your sleep partner about your snoring and sleep
behavior and how tired you feel during the day.

Your doctor may
suggest a
sleep study. A sleep study usually takes place at a
sleep center, where you will spend the night. Sleep studies find out how often
you stop breathing or have too little air flowing into your lungs during sleep.
They also find out how much oxygen you have in your blood during sleep. You may
have blood tests and X-rays.

How is it treated?

You may be able to treat mild sleep apnea by
making changes in how you live and the way you sleep. For example:

If lifestyle changes don't help sleep apnea, you
may be able to use an oral breathing device or other types of devices. These devices help keep your
airways open while you sleep.

Sleep apnea is often treated with a machine that helps you breathe
while you sleep. This treatment is called
continuous positive airway pressure, or CPAP (say
"SEE-pap"). Sometimes medicine that helps you stay awake during the day may be
used along with CPAP. If your tonsils, adenoids, uvula, or
other tissues are blocking your airway, your doctor may suggest surgery to open
your airway.

Cause

Obstructive sleep apnea usually occurs when the throat
muscles and tongue relax during sleep and partially or completely block the
airway. When you stop breathing or have reduced flow of air into your lungs
during sleep, the amount of oxygen in your blood decreases briefly.

Bone deformities, enlarged tissues

Obstructive sleep apnea can also occur if you have bone deformities or
enlarged tissues in your nose, mouth, or throat. For
example, you may have enlarged
tonsils. During the day when you are awake and
standing up, this may not cause problems. But when you lie down at night, the
tonsils can press down on your airway, narrowing it and causing sleep
apnea.

In children, the main cause of sleep apnea is large
tonsils or adenoids.

Other causes

Other things that may
contribute to sleep apnea include:

Drinking alcohol, which affects the part of the
brain that controls breathing. This may relax the breathing muscles and cause a
narrowing of the airway and sleep apnea.

Obesity. Fat in
the neck area can press down on the tissues around the airways. This narrows
the airways and can cause sleep apnea.

Some medicines that are taken for conditions such as
allergies,
long-term pain,
insomnia, or
anxiety. These medicines,
such as narcotics, can also relax the muscles and tissues in
the throat, causing it to narrow.

Symptoms

With sleep apnea, there are symptoms that you may notice and symptoms that others may notice when you're asleep.

Symptoms you may notice include:

Excessive daytime sleepiness.

Waking with an unrefreshed feeling after sleep, having
problems with memory and concentration, feeling tired, and experiencing
personality changes.

Morning or night headaches. About half of all
people with sleep apnea report headaches.1

Heartburn or a sour taste in the mouth at
night.

Swelling of the legs.

Getting up often during the night to urinate.

Sweating and chest pain while you are sleeping.

Symptoms others may notice include:

Episodes of not breathing (apnea), which may
occur as few as 5 times an hour (mild apnea) to more than 50 times an hour
(severe apnea). How many episodes you have determines
how severe your sleep apnea is.

Loud
snoring. Almost all people who have sleep apnea snore. But not all people who snore have sleep apnea.

Restless tossing and
turning during sleep.

Nighttime choking or gasping spells.

Symptoms in children

Children who have sleep apnea nearly always snore. But
they may not appear to be excessively sleepy during the day (a key symptom in
adults).

In children younger than 5, other symptoms include:

Mouth breathing.

Sweating.

Restlessness.

Waking up a
lot.

In children 5 years and older, other symptoms include:

Bed
wetting.

Doing poorly in school.

Not growing as quickly as they should for
their age. This may be the only symptom in some children. These children may also have behavior problems and a short attention
span.

When you stop breathing, the oxygen levels in your blood go
down and
carbon dioxide levels go up. This makes your heart and
blood vessels work harder and can affect your heart rate and
nervous system. That in turn may:

Lead to
other problems,
such as high blood pressure and
heart disease.

Because
sleep apnea disturbs your sleep, it can make you very tired during the day. So if
you have sleep apnea, you may:

Be more likely to have a car
accident.

Do poorly at school or work and have trouble concentrating.

Have memory problems.

Have personality
changes, anxiety, and depression.

Lose the desire for sex.

What Increases Your Risk

Certain things make it more
or less likely that you will have obstructive
sleep apnea. Some of these you cannot change,
while others you can.

Things you can't change

Aging. Sleep apnea is most common in people age
30 and older.

Being male. Sleep apnea is more common in men.

Family history. If other members of your family
have sleep apnea, you are more likely to have it than someone who doesn't have a family history of it.

Ethnicity. Hispanics and Pacific
Islanders have a greater risk of sleep apnea than whites. Blacks tend to get
sleep apnea at a younger age than whites.

Deformities of the spine. Deformities of the
spine, such as
scoliosis, may interfere with breathing and contribute
to sleep apnea.

Conditions that may cause head and face abnormalities. Conditions such as
Marfan's syndrome and
Down syndrome may result in abnormalities and increase the risk for sleep apnea.

Menopause. Sleep
apnea tends to occur more often in women who have been through
menopause than in women who have not. After menopause, women get sleep apnea at a rate similar to
men.1 Experts don't know why or how menopause
increases the risk of sleep apnea.

Things you may be able to change

Obesity. People who have sleep apnea
are
more likely to be obese. Obesity is the factor
most likely to lead to sleep apnea.

Neck circumference. People who are overweight may
have extra tissue around their neck, adding to their risk for sleep apnea. The
risk increases for a man whose neck measures more than 17 inches around and for
a woman whose neck measures more than 16 inches around.

Enlarged tissues of the nose, mouth, or throat. Enlarged tissues in the nose, mouth, or throat can
block your airway while you sleep, making sleep apnea
more likely. Surgery can sometimes correct the blockage and improve sleep
apnea.

Bone deformities. Bone deformities of the nose,
mouth, or throat can interfere with breathing, causing sleep apnea. Some people
who have sleep apnea have a small, receding jaw. Surgery can sometimes correct
these deformities and improve sleep apnea.

Use of alcohol or medicine. Drinking alcohol or
taking certain medicines before going to sleep can increase the risk for sleep
apnea. Medicines include some types of sleeping pills and
sedatives.

Sleeping on your back and using pillows. Sleeping
on your back and using one or more pillows may make sleep apnea
worse.

Smoking. Smoking can increase your risk for sleep
apnea, because the nicotine in tobacco relaxes the muscles that keep the
airways open.

Poor sleep habits. For example, going to bed in different places may increase your risk for sleep apnea.

Disorders of the hormone (endocrine) system. Disorders that may increase your risk include hypothyroidism and
acromegaly.

When To Call a Doctor

Call your doctor if:

You or your bed partner snores loudly and
heavily and feels sleepy during the day.

You notice that your bed
partner stops breathing, gasps, or chokes during sleep.

You
sometimes fall asleep at inappropriate times, such as while you are talking or
eating. Do not drive when you are drowsy.

Your child snores, has trouble breathing while sleeping,
sleeps restlessly, wakes up often, or is very sleepy during the day.

Watchful waiting

Watchful waiting is a wait-and-see approach. If
you get better on your own, you will not need treatment. If you get worse, you
and your doctor will decide what to do next. Watchful waiting may be right for
you if you snore but are not
excessively sleepy during the day.

Watchful waiting may not be right if you notice that your sleep
partner snores loudly and heavily, is restless during sleep, and is sleepy
during the day. If you think your sleep partner may have periods when
breathing stops, suggest that he or she talk with a doctor.

Who to see

Health professionals who can check people who have
symptoms of obstructive
sleep apnea include:

Exams and Tests

Your doctor will
examine you and ask you and possibly your sleep
partner some questions about your lifestyle, snoring, sleep behavior, and how tired
you feel during the day (this is called a
medical history).

Your doctor may ask you to complete
a questionnaire, such as the Epworth Sleepiness Scale. The answers to questions
in this questionnaire can help the doctor find out if you have sleep apnea. If
your doctor thinks that you may have sleep apnea, he or she may suggest that you have a sleep study in a lab or at your home.

Sleep studies
are a series of tests that record what happens to your body during sleep. Polysomnography is the main way to detect sleep apnea. This test records
electrical activity of your brain, eye movement, muscle activity, heart rate,
breathing, airflow through your nose and mouth, and blood oxygen levels (saturation).

Diagnosing sleep apnea in children

Most doctors follow these guidelines from the American Academy of Pediatrics:3

During a routine checkup, your doctor will ask you and your child
about snoring. If your child snores, be sure to tell your doctor.

A complete sleep study typically is needed to find out if your child
has sleep apnea and is not just snoring.

Children who have sleep
apnea and other disorders, such as Down syndrome or sickle cell disease, may need to see a specialist.

Testing after initial treatment

To see how well your treatment is working, you may need sleep tests after treatment begins.

If your sleep apnea has not improved after initial
treatment, and if
enlarged tissues in your mouth and throat are causing
it, your doctor may do one or more tests before suggesting surgery to remove
the excess tissue. These tests may include:

It may
take time for you to be comfortable using CPAP. You may find that you want
to take off the mask, or you may find it hard to sleep. If
you can't get used to CPAP, talk to your doctor. You might be able to try another
type of mask or make other adjustments.

Some
CPAP devices automatically adjust air pressure or use different air pressures
when you breathe in or out. They are easier and more comfortable for some
people to use.

If you use CPAP to treat sleep apnea, you need to use it every night. If you don't use it, your symptoms will return right away.

Other devices to help you breathe

Oral breathing devices reposition your tongue
and jaw during sleep, which opens up your airways. They may be used for people who have mild to moderate sleep apnea. They may also be used for people with severe sleep apnea who try CPAP but find out that it does not work out for them. A dentist will shape the device to fit your mouth.

Your doctor may suggest that you use nasal dilators (such as nose strips or disks) to help keep your airways open while you sleep. Nose strips widen the nostrils and improve airflow. Nasal disks have a valve that makes it harder for you to breathe out. This causes a little back-pressure in the airways that may help keep them open.
You can get many of these devices without a prescription. Talk to your doctor or pharmacist about your options.

Treatment for other health problems

You may need to be treated for other health problems
before you are treated for sleep apnea. For example:

People who also have
inflammation of the nasal passages (rhinitis) may
need to use nose spray to reduce the inflammation.

People who have an
underactive thyroid gland (hypothyroidism) need to take thyroid
medicine.

You may
also need treatment for
problems that sleep apnea may cause, such as
high blood pressure.

Treatment for children

Children have most of the same treatment options as adults.

Children who are overweight are encouraged to lose weight.

Surgery (removing tonsils or adenoids) typically is the
first choice, because enlarged tonsils or adenoids cause most cases of sleep
apnea in children.3

If surgery isn't possible
or doesn't work, children are treated using CPAP or may use corticosteroid medicine through the nose.3 In some cases, getting braces that widen the mouth can help children who have sleep apnea.

Prevention

You can help prevent obstructive
sleep apnea if you:

Don't use alcohol and medicines, such as
sleeping pills and
sedatives, before bed. These can relax your throat
muscles and slow your breathing.

Eat sensibly, exercise, and stay at a healthy weight.

Quit smoking. The nicotine in tobacco relaxes the
muscles that keep the airways open. If you don't smoke, those muscles are less
likely to collapse at night and narrow the airways.

Home Treatment

Home treatment for obstructive
sleep apnea includes lifestyle changes and changing some sleeping habits.

Lifestyle changes

Lose weight. Experts agree that
weight loss should be part of managing sleep apnea.5 If you are overweight and have sleep apnea, nutritional counseling and other treatments may help.

Limit the use of alcohol and medicine. Drinking
excessive amounts of alcohol or taking certain medicines, especially sleeping
pills or
sedatives, before sleep may make symptoms worse.

Get plenty of sleep. Apnea episodes may be more
frequent when you have not had enough sleep.

Quit smoking. The
nicotine in tobacco relaxes the muscles that keep the airways open. If you
don't smoke, those muscles are less likely to collapse at night and narrow the
airways.

Promptly treat breathing problems, such as a
stuffy nose caused by a cold or allergies.

One study found that people with sleep apnea who tend to have fluid collect in their lower legs and ankles may be helped by wearing compression stockings during the day.8 Keeping the fluid from collecting in the legs during the day may prevent the fluid from causing swelling of tissues in the nose and throat at night.

Sleeping habit changes

Sleep on your side. Try this: Sew a pocket in
the middle of the back of your pajama top, put a tennis ball into the pocket,
and stitch it shut. This will help keep you from sleeping on your back.
Sleeping on your side may eliminate mild sleep apnea.

Raise the head of your bed4 in. (10 cm) to
6 in. (15 cm) by putting bricks
under the legs of the bed. You can also use a special pillow (called a cervical
pillow) when you sleep. A cervical pillow can help your head stay in a position
that reduces sleep apnea. Using regular pillows to raise your head and upper
body won't work.

Use your CPAP machine every night. If you are using a
continuous positive airway pressure (CPAP) machine to
help you breathe, use it every night. If you don't use it all night, every
night, your symptoms will return right away.

Your doctor may also suggest that you use a breathing device while you sleep. It helps keep your airways open. This could be a device that you put in your mouth. Other examples include strips or disks that you use on your nose.

Talk to your doctor if you are sleepy during the day and this gets in the way of the normal things you do. It's important that you do not drive or operate machinery while you are drowsy.

Medications

Doctors typically don't suggest using medicines to treat obstructive
sleep apnea. Children may be given intranasal corticosteroid medicine for mild sleep apnea if surgery cannot be done or if the surgery did not work.3

Laser-assisted uvulopalatoplasty uses a laser to
perform surgery. It is sometimes used to treat mild to moderate sleep apnea,
although not all people benefit. This surgery is not recommended by the American
Academy of Sleep Medicine to treat sleep apnea.12

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